1932258019 NPI number — ELAINE ANNE TANCIOCO-ROKOSZ O.D.

Table of content: ELAINE ANNE TANCIOCO-ROKOSZ O.D. (NPI 1932258019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932258019 NPI number — ELAINE ANNE TANCIOCO-ROKOSZ O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANCIOCO-ROKOSZ
Provider First Name:
ELAINE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TANCIOCO
Provider Other First Name:
ELAINE
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1932258019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 E PINE LAKE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERNON HILLS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60061-1202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-968-2575
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9450 SKOKIE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SKOKIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60077-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-677-7202
Provider Business Practice Location Address Fax Number:
847-677-1258
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com